Jm. Palmisano et al., CHRONIC OTITIS-MEDIA REQUIRING VENTILATION TUBES IN TRACHEOTOMIZED VENTILATOR-DEPENDENT CHILDREN, International journal of pediatric otorhinolaryngology, 30(3), 1994, pp. 177-182
The occurrence of sinusitis and middle ear effusions has frequently be
en attributed to the obstruction of the sinus ostia and/or eustachian
tube. In the intensive care unit setting, edema caused by the irritati
on from nasogastric, nasotracheal and orotracheal tubes has been assoc
iated with this pathology and has been responsible for occult sepsis i
n this population. Our investigation was performed to determine the ri
sk of chronic otitis media with effusion necessitating myringotomy wit
h tympanostomy tubes among tracheotomized, ventilator dependent childr
en in a consecutive series of children admitted to our recently create
d stable ventilator unit. We retrospectively reviewed the medical reco
rds of all tracheotomized, chronically ventilator dependent children <
48 months of age who had been hospitalized in this unit from the init
ial opening in September 1990 to January 1993. Data collected consiste
d of patient demographics, gestational age, cognitive abilities, age a
t onset of mechanical ventilation, age at tracheostomy, age at myringo
tomy, presence of nasogastric and gastroenterostomy tubes and evidence
of gastric-esophageal reflux. All children underwent a tracheostomy p
rocedure subsequent to the onset of mechanical ventilation. Of these p
atients, 9/12 (75%) later required myringotomy with tympanostomy tube
placement following the occurrence of chronic otitis media with effusi
on. Ventilation tubes for chronic otitis media with effusion were not
required in 3 patients. Using a case control study design, we examined
the need of myringotomy tubes for children requiring continuous mecha
nical ventilation versus those requiring night-time only ventilation.
The risk of myringotomy tubes in the continuously ventilated group (9/
9) was significantly greater than the risk in the intermittently venti
lated group (0/3) P < 0.01. We conclude chronic otitis media with effu
sion is a common findingamong preschool-aged children who are tracheot
omized and ventilator dependent. Routine periodic ENT evaluation may b
e indicated in all pediatric patients who require chronic mechanical v
entilation. In this specific population of children, there may be a su
bset of patients who would benefit from prophylactic antibiotic therap
y or tympanostomy tube insertion during the duration of positive press
ure ventilation. Further prospective study is warranted.